**12. SAPPHIRE long-term results**

At 3 years, data were available for 260 patients (77.8%), including 85.6% of patients in the stenting group and 70.1% of those in the endarterectomy group. There was no significant difference could be shown in long-term outcomes between patients who underwent carotid artery stenting with an emboli-protection device and those who underwent endarterectomy The prespecified major secondary end point occurred in 41 patients in the stenting group (cumulative incidence, 24.6%; Kaplan–Meier estimate, 26.2%) and 45 patients in the endarter‐ ectomy group (cumulative incidence, 26.9%; Kaplan–Meier estimate, 30.3%) (absolute differ‐ ence in cumulative incidence for the stenting group, −2.3%; 95% confidence interval, −11.8 to 7.0). There were 15 strokes in each of the two groups, of which 11 in the stenting group and 9 in the endarterectomy group were ipsilateral.[18]

The SAPPHIRE data are specific to patients who are at high surgical risk, and they provide no insight into outcomes of treatment of a carotid artery stenosis in patients at low-to-moderate risk. On the basis of the similar long-term outcomes among high-risk patients in the two treatment groups, it may be tempting to infer that endarterectomy is preferable for lower-risk patients.
